Background
Mid Cheshire Hospitals NHS Foundation Trust manages Leighton Hospital, Crewe, the Victoria Infirmary, Northwich and Elmhurst Intermediate Care Centre, Winsford. It was originally established as an NHS Trust in April 1991 and became a Foundation Trust in April 2008. In 2012 it was awarded the Most Improved Trust award as part of the CHKS Top Hospitals awards programme.
Scale of challenge
The trust has been placing a great deal of emphasis on reducing its mortality rate as measured by the CHKS Risk Adjusted Mortality Index (RAMI). To find out more about RAMI visit the CHKS website www.chks.co.uk . Dr Paul Dodds, Medical Director and Deputy Chief Executive, says two years ago the trust set itself a target of reducing mortality by 10 points each year as measured by
the 12 month rolling RAMI. As part of this initiative the trust’s 12 month rolling RAMI was presented at Board of Directors meetings. A mortality sign off process was also introduced to improve links between coders and clinicians and, most importantly, focused pieces of work were initiated to ensure quality of patient care was prioritised.
Meeting the challenge
Regular monitoring of RAMI has been used to help the trust determine how mortality can be reduced in line with expectations. Working alongside their CHKS consultant, the trust has been able to identify specialties whose RAMI is higher than expected. Case note reviews are then carried out within these specialties to identify areas where quality of care can be improved. Paul says: “In common with most trusts the majority of our in-patient deaths occur in non-elective medical patients. Therefore we worked closely with our Department of Medicine, using mortality case note reviews to identify areas for improvement in clinical care and coding as appropriate.
One of the initiatives we introduced was to link individual coders to named consultants to ensure coders establish clear clinical diagnoses.”
“Within six months of the introduction of our Hospital Mortality Reduction Programme we started to see a definite change and the results were reflected in our RAMI score,” says Paul.
Benefits of working with CHKS
The insight provided by CHKS is helping the trust identify where improvements need to be made. The analysis plays an important part in the trust’s Mortality Reduction Programme which is led by the Hospital Mortality Reduction Group. This is chaired by Paul and includes a consultant physician, a consultant anaesthetist, the Director and Deputy Director of Nursing, the Head of
Information and the Trust’s Patient Safety Lead.
“Our CHKS consultant highlights areas where we are outlying, either by specialty or specific condition, and then we talk in detail about what the data shows and how best to deliver the required improvements. It is like having another early warning system,” says Paul. The trust has been able to reduce mortality in line with its target and its 12 month rolling RAMI has fallen from 112 in August 2010 to 92 in August 2012.
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